Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-12-01T00:08:35.295Z Has data issue: false hasContentIssue false
  • English
  • Français

Laboratory assessment of bacterial contamination of a sterile environment when using respirators not traditionally used in a sterile field environment

Published online by Cambridge University Press:  15 June 2022

Warren Myers ,
Segun Ajewole ,
Susan Xu ,
Patrick Yorio ,
Adam Hornbeck Open the ORCID record for Adam Hornbeck [Opens in a new window]  and
Ziqing Zhuang Open the ORCID record for Ziqing Zhuang [Opens in a new window]
Warren Myers
Affiliation:
Industrial and Management Systems Engineering, Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, West Virginia
Segun Ajewole
Affiliation:
Industrial and Management Systems Engineering, Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, West Virginia
Susan Xu
Affiliation:
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
Patrick Yorio
Affiliation:
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
Adam Hornbeck
Affiliation:
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
Ziqing Zhuang*
Affiliation:
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
*
Author for correspondence: Ziqing Zhuang, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

During infectious disease outbreaks or pandemics, an increased demand for surgical N95s that create shortages and necessitate the use of alternative National Institute for Occupational Safety and Health (NIOSH)–approved respirators that do not meet the Food and Drug Administration (FDA) additional requirements. The objective of this research was to quantify the level of bacterial contamination resulting from wearing NIOSH-approved respirators lacking the additional protections afforded by surgical N95s.

Methods:

Participants performed simulated healthcare tasks while wearing 5 different respirators approved by the NIOSH. Sterile field contamination resulting from use of a surgical mask cleared by the FDA served as a baseline for comparison with the NIOSH-approved respirators.

Results:

The bacterial contamination produced by participants wearing the N95 filtering facepiece respirators (FFRs) without an exhalation valve, the powered air-purifying respirators (PAPRs) with an assigned protection factor of 25 or 1,000 was not significantly different compared to the contamination resulting from wearing the surgical mask. The bacterial contamination resulting from wearing the N95 FFR with an exhalation valve and elastomeric half-mask respirator (EHMR) with an exhalation valve was found to be statistically significantly higher than the bacterial contamination resulting from wearing the surgical mask.

Conclusions:

Overall, NIOSH-approved respirators without exhalation valves maintain a sterile field as well as a surgical mask. These findings inform respiratory guidance on the selection of respirators where sterile fields are needed during shortages of surgical N95 FFRs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 12 , December 2022 , pp. 1867 - 1872
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

FDA Center for Devices and Radiological Health. Personal Protective Equipment for Infection Control. Beltsville, MD: Center for Drug Evaluation and Research; 2018.Google Scholar
Surgical N95 respirators. Centers for Disease Control and Prevention website. https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3surgicaln95.html. Published 2021. Accessed May 31, 2022.Google Scholar
Cooley, P, Lee, BY, Brown, S, et al. Protecting healthcare workers: a pandemic simulation based on Allegheny County. Influenza Other Respir Viruses 2010;4:61–72.CrossRefGoogle ScholarPubMed
Board on Health Sciences Policy & Institute of Medicine. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. Washington, DC: National Academies Press; 2015.Google Scholar
Roberts, V. To PAPR or not to PAPR? Can J Respir Ther 2014;50:87–90.Google ScholarPubMed
Wizner, K, Stradtman, L, Novak, D, Shaffer, R. Prevalence of respiratory protective devices in US healthcare facilities: implications for emergency preparedness. Workplace Health Saf 2016;64:359–368.CrossRefGoogle Scholar
Grinshpun, SA, Haruta, H, Eninger, RM, Reponen, T, McKay, RT, Lee, S-A. Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Envir Hygiene 2009;6:593–603.CrossRefGoogle Scholar
Workplace safety and health topics: healthcare workers. Centers for Disease Control and Prevention website. http://www.cdc.gov/niosh/topics/healthcare/. Published 2014. Accessed May 31, 2022.Google Scholar
Xu, SS, Lei, Z, Zhuang, Z, & Bergman, M. Computational fluid dynamics simulation of flow of exhaled particles from powered-air purifying respirators. In: Proceedings of the ASME 2019 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. Volume 1: 39th Computers and Information in Engineering Conference. Anaheim, CA: ASME; August 18–21, 2019.Google Scholar
Davidson, CS, Green, CF, Gibbs, SG, et al. Performance evaluation of selected n95 respirators and surgical masks when challenged with aerosolized endospores and inert particles. J Occupat Environ Hygiene 2013;10:461–467.CrossRefGoogle ScholarPubMed
Willeke, K, Qian, Y, Donnelly, J, Grinshpun, S, Ulevicius, V. Penetration of airborne microorganisms through a surgical mask and a dust/mist respirator. Am Indust Hygiene Assoc J 1996;57:348–355.Google Scholar
Kim, Y, Hale, M. Pilot study to examine the use of a powered air purifying respirator (PAPR) in the operating room. Am J Infect Control 2017;45:6 suppl: S84.Google Scholar
Howard, RA, Lathrop, GW, Powell, N. Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks. Am J Infect Control 2020;48:153–156.CrossRefGoogle ScholarPubMed
Candiotti, KA, Rodriguez, Y, Shekhter, I, et al. A comparison of different types of hazardous material respirators available to anesthesiologists. Am J Disast Med 2012;7:313–319.CrossRefGoogle ScholarPubMed
Chughtai, AA, Chen, X, Macintyre, CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control 2018;46:1329–1334.CrossRefGoogle ScholarPubMed
Chughtai, AA, Seale, H, Rawlinson, WD, Kunasekaran, M, Macintyre, CR. Selection and use of respiratory protection by healthcare workers to protect from infectious diseases in hospital settings. Ann Work Expos Health 2020;64:368–377.CrossRefGoogle ScholarPubMed
Wagner, JA, Greeley, DG, Gormley, TC, Markel, TA. Comparison of operating room air distribution systems using the environmental quality indicator method of dynamic simulated surgical procedures. Am J Infect Control 2019;47(1):e1–e6.CrossRefGoogle ScholarPubMed
Recommended practices for environment of care. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN; 2018.Google Scholar
Portnoff, L, Schall, J, Brannen, J, Suhon, N, Strickland, K, Meyers, J. Filtering facepiece respirators with an exhalation valve: measurements of filtration efficiency to evaluate their potential for source control. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2021–107; 2020.Google Scholar